Arthritis Flashcards
What are the 3 goals of exercise intervention for arthritis?
- Slow or reverse the body’s response to joint pathology by increasing strength, flexibility, endurance, and by decreasing pain
- Improve impairments, functional limitations, and disabilities associated with arthritis
- Improve health due to cardiovascular, strengthening, ROM, and stretching
How does osteoarthritis begin? What is the next step
- Asymmetric cartilage loss –> Abnormal forces on the joint
- This leads to soft-tissue imbalance, joint malalignment, and bony hypertrophy
How does rheumatoid arthritis begin? What is the next step?
- Pannus formation
- Erosion of cartilage and bone
- Cartilage destruction
- Bone destruction
- Soft tissue destruction
- Joint capsule fibrosis
What does the anatomic damage of RA lead to?
- Joint malalignment
- Instability
- ROM loss
Which arthritis is inflammatory?
RA
Which arthritis is localized?
OA
Which arthritis is systemic?
RA
Which arthritis affects several organ systems?
RA
What is the function of articular cartilage, and how it affected by OA and RA?
Function: Shock absorption, joint congruence
OA: Thickening to softening, to thinning to loss
RA: Erosion
What is the function of the synovium, and how is it affected by OA and RA?
Function: Secretes synovial fluid for cartilage nutrition, lubrication, and stability
OA: Abnormal joint alignment stresses
RA: Microvascular lining cells activated by inflammatory process, pannus formation
What is the function of ligaments, and how are they affected by OA and RA?
Function: Stability, reinforce capsule, and limit movement, guide movement
OA: Abnormal joint alignment stresses
RA: Erosion; weakens
What is the function of muscles, and how are they affected by OA and RA?
Function: Reinforce joint capsule, reflex joint protection, move joints
OA: Immobility shortens pain, causes gaurding and reflex inhibition, leading to weakness
RA: Joint deformity interferes with peak torque, immobility shortens muscles, myositis weakens, pain and effusion cause gaurding, reflex inhibition leads to weakness
What is the function of bone, and how is it affected by OA and RA?
Function: Structural support
OA: Subchondral bone remodeling changes shock absorbing properties, and joint margin spurring leads to bony blockage and pain
RA: Erosion leads to joint deformity, bony blockage, pain
What is impact of OA and RA on extra-articular systems?
OA: Increased energy expenditure from abnormal movement patterns
RA: Myositis, anemia, sleep disruption, fatigue, increased energy expenditure from abnormal movement patterns.
Describe class I, II, III, and IV RA in terms of function.
Class I: Perform usual ADLs
Class II: perform ADLs and vocational activities, limited in avocational activities
Class III: Perform ADLs, but limited in vocational and avocational activities
Class IV: Limited in ability to perform ADLs, vocational, and avocational activities
What may be present on x-ray in stage I RA?
- Osteoporosis
What may be present on x-ray in stage II RA?
- Osteoporosis
- With or without subchondral bone destruction
- Slight cartilage destruction
What may be present on x-rays in stage II RA?
- Cartilage destruction
- Bone destruction
- Osteoporosis
Describe the presence of joint deformities, muscle atrophy, extra-articular soft tissue lesions in stage II, III, and IV RA.
Stage II:
- No joint deformities; possible limitation of mobility
- Muscle atrophy
- Extra-articular soft tissue lesions (nodules and tenosynovitis)
Stage III:
- Joint deformity such as subluxation, ulnar deviation, or hyperextension
- Extensive muscle atrophy
- Extra-articular soft tissue lesions (nodules, tenosynovitis)
Stage IV:
- Fibrous or bony ankylosis
What are the 4 components of an appropriate exercise regimen for prevention of arthritis?
- Maintain appropriate body weight
- Sustain good postural alignment
- Develop good muscular strength and length
- Correct movements during functional activities
What are the 4 components of an exercise regimen for a patient with osteoarthritis?
- Decrease pain and inflammation
- Re-establish muscle length and strength around joint
- Address adaptive changes in proximal and distal joints
- Performance of basic functional tasks
How does exercise prescription differ for a patient with RA from a patient with OA?
- The Pt should be taught how to recognize symptoms, and modify activity according to symptom development and stage of disease
Describe the 8 step progression of pain due to arthritis and its effect on function.
- Pain, swelling, splinting
- Disuse atrophy
- Reduced protective reflexes
- Further cartilage breakdown
- Disruption of soft tissue balance
- Inefficient movement/ muscle patterns
- Decreased cardiovascular activity
- Further activity reduction
How does therapeutic exercise help prevent the progression of pain and loss of function?
- Restores muscle balance
- Restores ROM
- Restores CV conditioning
- Modalities help control pain
What are 3 factors that can diminish range of motion from arthritis?
- Stiffening/ shortening of muscles or tendons from spasm, guarding, or habitual postures
- Capsule stiffness or contracture
- Loss of joint congruity secondary to bony deformity
How is muscle performance addressed in Rheumatoid arthritis?
- 1 - 2 daily applications of PROM (large joints) and AROM (small joints)
- Single submaximal isometric contractions, 6 secs on/ 20 secs off
- Repeat at various angles
How is muscle performance addressed in an acute phase of osteoarthritis?
- Isometric contractions
How muscle performance addressed in osteoarthritis once pain and swelling decrease?
- Dynamic contractions as appropriate
For what types of arthritis is CV training an important part?
Class I and II RA, and all OA
What specific type of CV training is particularly helpful with arthritis? Why?
Aquatic Therapy:
- Allows performance of movement patterns that may not be possible on land because of balance or strength deficits
- Provides muscle relaxation
- Modifies pain perception through sensory stimulation
When should a joint be protected during strengthening?
- When ligament or capsular laxity exists
When should muscle balance be restored in arthritis?
- Splinting
- Postural habit
- Pain inhibition
- -> These have weakened muscles groups around one or more joints
What are 3 special general considerations for patients with arthritis and exercise?
- Normalize specific joint movement patterns
- Restore functional activities
- Treat pain during and after
